Provider Demographics
NPI:1053829077
Name:DANIELS, KAITLYN (MA)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17
Mailing Address - Street 2:
Mailing Address - City:WANCHESE
Mailing Address - State:NC
Mailing Address - Zip Code:27981-0017
Mailing Address - Country:US
Mailing Address - Phone:252-423-0267
Mailing Address - Fax:
Practice Address - Street 1:3210 NORTH CROATAN HIGHWAY
Practice Address - Street 2:SUITE 1A
Practice Address - City:KILL DEVIL HILLS
Practice Address - State:NC
Practice Address - Zip Code:27948
Practice Address - Country:US
Practice Address - Phone:252-423-0267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13642101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional